Long-term Outcomes and the Predictors Following Microvascular Decompression and Gamma Knife Radiosurgery for Drug Refractory Primary Trigeminal Neuralgia: A Single-Center Experience with a Large Cohort
Tanuj J. Presswala, Harsh Deora, Dwarakanath Srinivas, Gyani J. S. Birua, Abhinith Shashidhar, Subhas K. Konar, Manish Beniwal, Kannepalli V. L. N. Rao, Arivazhagan Arimappamagan, Dhaval Shukla, Rao M. Bhaskara, Sampath SomannaAbstract:
Background:
We analyze our results and outcome multimodality management of idiopathic trigeminal neuralgia (TN).
Objective:
To evaluate long-term outcomes and the predictors following microvascular decompression (MVD) and gamma-knife radiosurgery (GKRS).
Methods:
A retrospective review of patients with drug-refractory primary TN treated between 2015 and 2024, with a minimum follow-up of 12 months. Treatment outcomes were assessed using Barrow Neurological Institute (BNI) pain scores at follow-up. Complete pain relief (CPR) was defined as BNI 1 or 2, adequate pain relief (APR) as BNI 3, and treatment failure as BNI 4 or 5.
Results:
Of 263 patients, 175 underwent MVD and 88 underwent GKRS. The mean duration of follow-up was 58.3 ± 30.2 months (MVD) and 68 ± 34.5 months (GKRS). CPR was achieved in 86.8% (MVD) and 56.8% (GKRS) patients. The recurrence rate was 12% (MVD) and 20.45% (GKRS), with a median time to recurrence of 4 and 21 months, respectively. Incomplete immediate postoperative pain relief after MVD predicted treatment failure and recurrence (
Conclusion:
MVD provides excellent immediate (94%) and durable (86%) pain relief in surgically fit patients, with early response predicting sustained outcomes; recurrence is associated with multisegment involvement and higher preoperative pharmacological requirement. GKRS offers a reasonable alternative (71% short-term, 57% long-term relief) and is especially useful in patients either unfit for surgery or unwilling for surgery.